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Adénocarcinome ductal de la prostate, quatre ans de suivi
2008
- Réf : Prog Urol, 2008, 13, 18, 1093-1096


Introduction



Ductal adenocarcinoma of the prostate (DAP) is an unusual form of prostatic cancer rising in the light of the acini and prostatic ducts with preservation of their architecture. We report the case of a 78-year-old patient presenting a pure ductal adenocarcinoma of the prostate locally advanced, with a four years’ follow-up. With this case, we report the principal aspects of the literature.

Mots clés:
Adénocarcinome ductal / prostate / Hormonothérapie
Mots-clés:
ductal adenocarcinoma / prostate / Hormonotherapy
Carcinome in situ vésical et urétral chez un patient transplanté rénal : échec de la BCG thérapie
2008
- Réf : Prog Urol, 2008, 13, 18, 1097-1099


Introduction



We report the case of a 67-year-old patient, renal transplanted for two years, taken care for carcinoma in situ in bladder and urethra, and treated by intravesical instillations with bacillus Calmette–Guerin (BCG). After failure of a first treatment by Amétycine®, a treatment by BCG is instituted during nine weeks. Two months after the end of the treatment, the patient died after bone and liver metastatic invasion of urothelial carcinoma. Management of urothelial high-risk tumour among renal transplanted patient is not clear. Despite successful treatments of few patients reported in literature, this failure called the question of the effectiveness of the BCG therapy in renal transplant patient and suggested an earlier attempt at diagnosis with systematic detection and aggressive therapeutic among these immunodepressed patients.

Mots clés:
Transplantation rénale / BCG / carcinome urothélial
Mots-clés:
Renal transplantation / BCG / Urothelial carcinoma
Diminution du rapport ApoB/ApoA-1 et amélioration du risque cardiovasculaire : effet pleïotropique du tadalafil ? Étude préliminaire sur volontaires sains
2008
- Réf : Prog Urol, 2008, 13, 18, 1087-1091


Introduction



Objectives

Recognition of erectile dysfunction (ED) as an early sign of systemic cardiovascular disease offers an opportunity for prevention. Cardiac risk assessment may deserve measurement of Apolipoprotein B/Apolipoprotein A-1 ratio. An elevated ApoB/ApoA-1 ratio is a risk factor for future coronary artery disease. ApoA-1 production, which is recognized as a cardioprotective lipid fraction, is down regulated by NFκB activation in vitro. Because inhibition of phosphodiesterases (PDEs) 5, 6 and 9 negatively attenuates NFκB translocation/activation, tadalafil, a selective PDE 5 inhibitor used for treatment of ED could present some interesting pleiotropic effects. The objective of this open study is to test the hypothesis that tadalafil treatment could decrease serum ApoB/ApoA-1 ratio.


Material and methods

Ten healthy men without any complain of ED or known cardiovascular risk factors were administered tadalafil 10mg intake on alternate days for 4 weeks. Lipid profile with total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, ApoA-1 and ApoB, was assessed at baseline (T0), after 2weeks (T1), at the end of the treatment period (T2) and after 2weeks of wash-out follow-up (T3).


Results

ApoB/ApoA-1 ratio was significantly decreased during treatment (mean±SEM, T0: 0.80±0.11, T1: 0.64±0.06, T2: 0.65±0.06; p <0.05) and remained lower after wash-out (T3: 0.67±0.05; p =0.08). Serum ApoA-1 (mg/dl) increased but not significantly during the treatment period (15.2±8.8, 16.5±7.9, 16.9±6, 15.3±7, p =0.26) and ApoB (mg/dl) significantly decreased (11.7±10.8, 10.3±8.4, 10.6±9.9, 10.2±8.6, p =0.03). HDL and LDL cholesterol were unchanged.


Conclusion

This preliminary study showed the interest of PDE 5 inhibitors to decrease the cardiac risk factor ApoB/ApoA-1 ratio. Randomised controlled studies with longer follow-up are needed to confirm those results.

Mots clés:
Troubles érectiles / Phosphodiestérases / Tadalafil / Effet pleïotropique / Apolipoprotéine A-1
Mots-clés:
erectile dysfunction / Phosphodiestérases / Tadalafil / Pleiotropic effect / Apolipoprotein A-1
Erratum à « La taille tumorale limite-t-elle encore les indications de la néphrectomie partielle en 2008 ? » [Prog Urol 2008;18(8):487-92]
2008
- Réf : Prog Urol, 2008, 13, 18, 1100-1101


Deux erreurs se sont glissées dans le volume 18, numéro 8/2008 de Progrès en urologie .
• dans l’avant dernière phrase du résume, page 487, il fallait lire :
De plus, le surcroît de morbidité induit par l’élargissement des indications de la néphrectomie partielle semble acceptable.

Mots clés:
M. / K. / J.-J.
Mots-clés:
Renal transplantation / BCG / Urothelial carcinoma
Évaluation économique de l'urétéroscopie souple laser
2008
- Réf : Prog Urol, 2008, 13, 18, 1050-1055


Introduction



Purpose

The purpose of our study was to make an evaluation of the effective cost of a session of deflexible ureteroscopy with laser to cure kidney stones and kidney urothelials tumors.


Material

This cost was calculated based on 103 sessions (83 kidney stones, 18 urothelials tumors, one cyst and one endopyelotomy) carried out on 73 patients and was including (1) staff expenses in the operation room (based on work time stated on the anesthesia sheet); (2) material expenses: technically specific or not. Reusable or single use; (3) amortisement of medical supply calculated on a seven year basis; (4) hospital stay. In this study medical logistic expenses and administrative expenses were not taken into account as well as structural expenses which were considered apart of this activity.


Results

Cost of a laser deflexible ureteroscopy was estimated by more or less 4237.3€, including 1677.6€ for hospital charges. The cost of a session was 4490.5€ for a tumor and 4141.4€ for a stone, however the difference was not significant. Cost without hospital charges was estimated by 1196.5€.


Conclusion

The main part of a laser deflexible ureteroscopy session cost was the consequence of hospital expenses. It could only be obtained in a structure running a sufficient activity level depend on amortisement of medical supply.

Mots clés:
Urétéroscopie souple / Laser / Coût
Mots-clés:
Deflexible ureteroscopy / Laser / cost
Index des auteurs
2008
- Réf : Prog Urol, 2008, 13, 18, 1102-1105


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Mots clés:
M. / K. / J.-J.
Mots-clés:
Renal transplantation / BCG / Urothelial carcinoma
Index des mots cles
2008
- Réf : Prog Urol, 2008, 13, 18, 1106-1118


Le texte complet de cet article est disponible en PDF.
Cliquer ici pour le visualiser

Mots clés:
M. / K. / J.-J.
Mots-clés:
Renal transplantation / BCG / Urothelial carcinoma
Inhibiteurs de la 5-phosphodiestérase et risque cardiovasculaire
2008
- Réf : Prog Urol, 2008, 13, 18, 1091-1092

Mots clés:
J.
Mots-clés:
erectile dysfunction / Phosphodiestérases / Tadalafil / Pleiotropic effect / Apolipoprotein A-1
La chirurgie du cancer de la prostate au stade localement avancé. Revue du comité de cancérologie de l'AFU (sous-comité « Prostate »)
2008
- Réf : Prog Urol, 2008, 13, 18, 1031-1037


Introduction



Among the different options recommended for locally advanced prostate cancer (LAPC), radical prostatectomy (RP) is a relatively infrequent option because its role is still controversial. The results of clinical trials combining an external radiotherapy to a long-term androgen deprivation sustain the principle of a multidisciplinary management of LAPC. Impact of surgery on the risk of progression and local recurrence is important in selected patients with low grade and small tumoral volume. Clinical and histological data associated to the MRI assessment remain essential and enhance the preoperative multidisciplinary decision. Oncological results from recent series show 10-year and 15-year specific survival rates around 85 and 75%, respectively. Moreover, approximately 20 to 30% of patients initially presented with cT3 tumours have finally an organ-confined disease on pathological examination. Morbidity of the procedure is similar to RP for organ-confined tumours despite more erectile dysfunction due to non-sparing RP in most of cases. An enlarged RP with an extended pelvic lymphadenectomy can be considered as a viable alternative to radiotherapy and hormonal therapy in patients with long life expectancy presenting cT3 tumour with a high risk of local progression and a low risk of metastatic disease. Comparative and combined treatments including RP have to be prospectively investigated in clinical trials in terms of oncological outcome and quality of life.

Mots clés:
Cancer de la prostate localement avancé / Prostatectomie totale / Lymphadenectomie pelvienne étendue / Traitements combinés
Mots-clés:
locally advanced prostate cancer / radical prostatectomy / Extended pelvic lymphadenectomy / Combined treatments
La lithiase urinaire chez l'enfant tunisien. Étude à propos de 187 cas
2008
- Réf : Prog Urol, 2008, 13, 18, 1056-1061


Introduction



Objective

The aim of this study is to define epidemiologic and structural particularities of urinary stones in Tunisian children.


Patient and methods

Between 1995 to 2007, 187 stones of Tunisian children were studied. Structural analysis was performed by infrared spectrophotometry.


Results

We analyzed 187 stones from 122 boys and 65 girls. Their age ranged from two months to 18 years. Our study shows a male predominance with a sex ratio of 1,88.

Stones were renal in 64.8%, ureteral in 20.6% and 14.6% were vesical. Whewellite was the main component (49,2% of stones) with a female predominance. Among phosphatic stones, carbapatite was in the lead (10.7%) followed by struvite (7%), which predominate in male.


Conclusion

The epidemiological profile of urinary stones in children in Tunisia is situated between that observed in developed countries and that observed in developing countries.

Mots clés:
Lithiase urinaire / Enfants tunisiens / spectrophotométrie infrarouge
Mots-clés:
urinary stones / Tunisian children / Infrared spectrophotometry
La place de la chirurgie des métastases osseuses dans le cancer du rein : à propos de 13 cas
2008
- Réf : Prog Urol, 2008, 13, 18, 1045-1049


Introduction

Surgery for osseous metastases seems to improve the patients with renal cell carcinoma. The goal of this study is to evaluate the efficacy and safety of surgery for osseous metastases from renal cell carcinoma.


Materials

We performed 21 surgery for osseous metastases in 13 patients who have been treated for metastatic renal cell carcinoma at one institution between 2001 and 2007. The surgical procedure included curetage with cementing and or internal fixation, in bloc resection or surgical decompressive procedure. Disease-free and overall survival was calculated using Kaplan–Meïer analysis.


Results

The overall patient survival rate at one year was 84%. The overall median survival time was 23months (IC95%; 16,9–78,1%). The disease-free survival was 19 months (IC95%: 26,7%–80,9%) after surgery. Positive margins were observed in 9 patients (R2) and negative margins in 8 patients (R0). R0 and R2 resections have no impact on local relapse. Minor complications occurred in two patients. There was no intra- or postoperative hemorrhage.


Conclusion

Surgery of osseous metastases is safe and effective and seems to improve outcomes of metastatic renal cell carcinoma.

Mots clés:
Métastases osseuses / Chirurgie / Adénocarcinome à cellules claires du rein
Mots-clés:
Osseous metastases / Surgery / Renal cell carcinoma
Mortalité et morbidité des cystectomies totales pour cancer de la vessie chez les patients de plus de 75 ans
2008
- Réf : Prog Urol, 2008, 13, 18, 1062-1067


Introduction



Objective

The objective of this study was to evaluate the mortality and morbidity of cystectomy and the functional results of the associated diversions in patients over the age of 75 operated for bladder cancer.


Material and methods

From 1988 to 2002, 37 patients (29 men and 8 women) aged between 75 to 88 years (median: 79 years) underwent radical cystectomy for bladder cancer. All patients had at least one comorbidity factor, 17 patients were classified as ASA II (45.9%) and 20 were classified as ASA III and IV (54.1%). An external urinary diversion was performed in 35 patients and orthotopic bladder replacement was performed in two patients. The mean follow-up was 21.0 months (range: 0.3–88.6). The mortality, early and late morbidity, and functional results were analyzed.


Results

There was no intraoperative mortality and the early mortality rate was 5.4% (2/37). The early medical morbidity rate was 24.3%, essentially cardiovascular (pulmonary embolism, myocardial infarction, pulmonary edema), and the early surgical morbidity rate was 2.7%. The late morbidity rate was 27.0%, essentially corresponding to wound complications (peristomal or midline incisional hernias). In terms of functional results, a peristomal incisional hernia with stoma appliance difficulties was observed in 11.4% of patients with an external diversion. One of the two patients treated by bladder replacement performed intermittent self-catheterization and the other was continent during the day and required pads at night.


Conclusion

This study shows that the acceptable mortality and early and late morbidity results allow radical cystectomy to be proposed in patients over the age of 75.

Mots clés:
mortalité / morbidité / Cancer de vessie / Cystectomie / Patients âgés
Mots-clés:
mortality / Morbidity / bladder cancer / Cystectomy / Elderly patients
Prise en charge du tératome pur testiculaire postpubertaire à propos d'une série multicentrique sur 15 ans
2008
- Réf : Prog Urol, 2008, 13, 18, 1075-1081


Introduction



Objective

To analyze cases of pure teratoma of the testis (PTT) of a large population-based study, as such tumors are rare, and to make an update on the topic.


Patients and methods

We retrospectively reviewed the records of patients treated for PTT from 1987 to 2003 in the French Midi-Pyrenees region (southwestern France) and in the Val-de-Grâce military hospital, Paris. Among more than 1000 cases of testis cancer, we identified 20 cases of PTT (4% of the whole population). For each patient, the orchiectomy specimen was reviewed and a clinical and imaging re-evaluation was performed.


Results

The pathological re-evaluation revealed non-teratomatous components in three patients (excluded from a following analysis). For the localized PTT patients, four out of eight out of 8 were on surveillance only after the orchiectomy, and the remaining four received adjuvant chemotherapy. None of them received any lymphadenectomy for staging. All patients with the metastatic disease were treated by chemotherapy followed by surgical removal of residual tumor masses. With a mean of 125 months follow-up, 85% of the population did not relapse after treatment. At the last contact, all were alive, without the disease.


Conclusion

We confirm that PTT is a malignant disease with a good prognosis. As its management differs from the other non-seminomatous germ cell tumors, the diagnosis of PTT must be with certainty. The retrospective analysis of a series over two decades highlights the deviations from current guidelines. We propose that this rare tumor of young man should be treated in specialized centers to get the optimal management.

Mots clés:
Tératome / Cancer du testicule / Curage ganglionnaire / tumeur germinale / Pratiques cliniques
Mots-clés:
Testicular teratoma / Testis neoplasms / Lymphadenectomy / germ cell tumor / Clinical practice
Prothèses testiculaires après orchidectomie : enquête de satisfaction auprès des patients et de leurs partenaires
2008
- Réf : Prog Urol, 2008, 13, 18, 1082-1086


Introduction



Objective

To assess the satisfaction of men and of their partner towards their testicular implants after undergoing orchidectomy.


Materials and methods

Hundred and twenty-four consecutive patients, who had undergone orchidectomy, and their partner were sent an anonymous questionnaire. The follow-up after the implantation was at least one year. The testicular implants used were all Perthèse®.


Results

Seventy-two patients answered to the questionnaire, among whom 63 had a testicular implant. Fifty-eight partners answered. From the patients with implant, 5% thought their body image was worse than before the operation and 80% thought their sexual activity was unchanged. Ninety-six percent thought the implantation was worthwhile and would do it again if they had to do the choice again. The reasons for dissatisfaction were: for the shape (n =8), for the size (n =3), for the position (n =2) and one patient thought the implant was too cold. Forty percent of the partners did not care about the implants and 58% thought the implant was essential. The dissatisfaction rate for the partners was 26% and reasons for were: for the shape (n =5), for the size (n =2), and one partner thought the implant was too cold. From the patients without implant, only one is thinking about having one.


Conclusion

Testicular implants are well accepted, but some reasons of dissatisfaction appeared in our study. It was the first evaluation of the partner’s satisfaction.

Mots clés:
testicule / Prothèse testiculaire / Perthèse / / Orchidectomie
Mots-clés:
Testicle / Testicular implants / Perthèse / / orchidectomy
Pseudokystes periurétraux en complication des injections urétrales de Zuidex ® : revue de la littérature
2008
- Réf : Prog Urol, 2008, 13, 18, 1038-1043


Introduction



Periurethral dextranomer/hyaluronic acid (Zuidex®) is a mini-invasive technique for female stress-urinary incontinence and minimal adverse effects were described. Pseudocysts were recently described. Twenty-nine cases only are reported in the literature and the authors illustrate the review with an additional case. Asymptomatic cases, pain and low stream were observed. On clinical examination, a tenderness or visible periurethral deformation need to precise the characteristics with ultrasonography and MRI. Symptomatic cases may benefit from puncture, although the patients must be informed of a potential recurrence of the incontinence.

Mots clés:
incontinence urinaire / Injection urétrale / technique chirurgicale
Mots-clés:
Urinary incontinence / periurethral injection / Surgical procedure
Récidive des pseudokystes périurétraux après ponction aspiration
2008
- Réf : Prog Urol, 2008, 13, 18, 1043-1044


Cet article de revue se base sur une recherche bibliographique à l’aide du moteur de recherche Pubmed , des cas traitants les pseudokystes périurétraux secondaires à une injection urétrale de Zuidex®. Les auteurs ont retrouvé cinq articles qui ont fait état de cette complication spécifique.

Mots clés:
P.
Mots-clés:
Urinary incontinence / periurethral injection / Surgical procedure
Résultats à long terme de la promontofixation laparoscopique dans les cystocèles de haut grade
2008
- Réf : Prog Urol, 2008, 13, 18, 1068-1074


Introduction



Purpose

To evaluate long-term functional and anatomical results of laparoscopic-sacral colpopexy (LSC) for the treatment of high-grade cystoceles.


Material

Between 1997 and 2005, 43 women with symptomatic cystoceles of high grade (grade 3 or 4), isolated or not, were treated by LSC. All patients were seen at three months, six months and then yearly during follow-up. Each visit included an interrogatory searching for functional urinary symptoms or sexual and digestive symptoms. A clinical examination, always performed by the same operator, searched for an anatomical recurrence, which was defined by an anterior prolapse of stage greater or equals to 2. In addition, a uroflowmetry was performed systematically. Prognostic factors for cystocele recurrence were established by univariate analysis.


Results

With a mean follow-up of 4.1 years (2–10.1), the rate of correction of cystocele was 84%. Seven women had an anterior recurrence and were as follows: stage 2 (n =5), stage 3 (n =1) and stage 4 (n =1) associated with urinary-functional symptoms in three cases, with sexual problems in three cases or with rectal symptoms in two cases. In case of isolated cure of cystocele, we found no recurrence during follow-up. Mean uroflowmetry was 24±9ml/s. Nine women (21%) had dysuria associated with cystocele recurrence in four cases. Four patients had a pollakiuria (n =1), an urgenturia (n =1) or a stress-urinary incontinence (n =2) without anatomical recurrence. In a case, chronic-pelvic pain was revealing erosion of the tape into the bladder wall. No significant factor was associated with cystocele recurrence.


Conclusion

LSC offered a viable and long-lasting correction of high-grade cystoceles, mostly when they are isolated. Anatomical recurrence was mainly revealed by the occurrence of functional symptoms. In case of atypical urinary symptoms, a cystoscopy has to be done to look for an erosion into the bladder wall.

Mots clés:
cystocèle / Promontofixation / incontinence urinaire / laparoscopie / Femme
Mots-clés:
cystocèle / Sacral colpopexy / Urinary incontinence / Laparoscopy / Women